<div id=tiga_ba>
	<div id=tiga_baa>Tambah Jenis PPK</div>
	<div id=tiga_bab></div>
	<div class=clear></div>
</div>
            
<form action="utama.php?module=mod_jppk&act=simpan" onsubmit="return gsValidate('nama|tarif','Jenis Tarif Harus Diisi|Pola Tarif Harus Dipilih','required|required');" method="post" enctype="multipart/form-data">
	<table style="margin: 10px 15px 10px 15px;">
		<tr>
			<td>Jenis PPK</td>
			<td>
				<input name="nama" type="text" class="input2" id="nama" maxlength="50" />
				<span class="red">*</span>
			</td>
		</tr>
		<tr>
			<td>Pola Tarif</td>
			<td>
				<select name="tarif" class="input2">
					<option value=""> - - Pilih Pola Tarif - - </option>
					<?php
						$pola = mysql_query("select * from pola_tarif");
						while ($p = mysql_fetch_array($pola)){
							echo "<option value=$p[id_pola] $s>$p[pola_tarif]</option>";
						}
					?>
				</select>
				<span class="red">*</span>
			</td>
		</tr>
		<tr>
			<td valign="top">Keterangan</td>
			<td>
				<textarea name="keterangan" class="area"></textarea>
			</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
			<td><input name="submit" type="submit" class="button" value="Simpan" /></td>
		</tr>
	</table>                
</form>		
            
        